POS1546-HPR DISEASE ACTIVITY BURDEN FOR LONG TERM RHEUMATOLOGY FOLLOW-UP PATIENTS
Authors: G. Ansari, K. Manik, A. Nandagudi, A. Bharadwaj
Journal: Annals of the Rheumatic Diseases (2022)

Background There has been a lot of emphasis for early diagnosis and treatment for immune mediated rheumatology conditions such as Treat to target (T2T) for inflammatory arthritis, Fast track pathway for Giant cell arteritis. However, the data regarding burden of disease activity, nature and proportion of long term rheumatology follow up patients in rheumatology clinics have not been explored. There are conditions which are refractory to treatment or affected by recurrent flare-ups requiring long term follow-ups and constant monitoring. With increasing life expectancy and better treatment of the long term conditions, emphasis on long term disease activity monitoring is under strain. It is important to understand the nature of illnesses and treatment of long term follow-up patients to decide management strategies. Objectives The aim of this quality improvement project was to understand profile of disease and management of patient being seen as long term follow-up (defined as &gt;2 years follow-up after their first presentation in specialist clinic). Methods This was a single point, retrospective cohort analysis of patients seen in rheumatology clinics in a district general hospital, UK in March 2021. We reviewed consecutive 120 follow-up patients and recruited 80 patients who had &gt;2yrs follow-up. We have a community rheumatology service arm where all patients with stable inflammatory arthritis on non-biologic treatments are reviewed while patients with multisystem complicated illness and biologics are seen in secondary care. The stable patients from community clinics have not been included in this analysis. The data was reviewed using clinic letters, date of first appointment &amp; last appointment. We looked at gender, age, diagnosis, number of follow ups in the first and last year, disease activity scores of the respective diagnosis and treatment given. Results Sixty six percent of follow-up patients are long term with complicated illness or treatment. Of these 52 patients (65%) were female with median age 64 years (range 23-94 years). Median duration of follow up for this group of patients was 6 years (range 2-11 years). Inflammatory arthritis was the most common diagnosis in 75% of patients (11 patients were Psoriatic arthritis, 30- Rheumatoid arthritis, 7- undifferentiated inflammatory arthritis and 7- Axial spondyloarthritis), 17.5% connective tissue disease, 11.2% vasculitis and others (Still’s disease) 3.7%. Some patients had more than one diagnoses. The number of follow ups in the first year ranged from 1-13 (median 4). In final year of analysis, patients were seen median of 3 times (range1-8). Amongst them, 25% of patients were seen 4 or more times. The commonly prescribed drugs were methotrexate (41.2%), sulfasalazine(17.5%), hydroxychloroquine(15%), leflunomide (7.5%),biologics (8.7%), mycophenolate mofetil and azathioprine (6.5%).The activity scores such as DAS28, BVAS, PsARC and BASDAI were documented in 46 patients (57.5%). Conclusion This study shows that 66.6% of follow-up patients in rheumatology clinics are complicated long term conditions on immunomodulatory treatment. Despite T2T approach, use of combination DMARDs and early use of biologics, majority are inflammatory arthritis. It also shows that even after median follow-up of 6 years, these patients require an average review 3 or more times per year. The reasons for this may be poor disease control, disease complications, comorbidities and medication side effects. Further analysis is ongoing to look into these aspects for better disease control and long term outcome. Disclosure of Interests None declared